POS0187 HEPATIC STEATOSIS AND FIBROSIS IN PATIENTS WITH GOUT DETECTED BY ELASTOGRAPHY
Authors: N. Schlesinger, A. Patel, V. Rustgi, A. Yeo, P. Lipsky
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Gout is associated with non-alcoholic fatty liver disease (NAFLD), but neither the frequency nor severity of NAFLD in gout is well described. Elastography is a well-established ultrasonic method to evaluate both steatosis and fibrosis in the liver but has not been applied to evaluate gout patients. <h3>Objectives</h3> To determine how common hepatic steatosis and fibrosis are in patients with gout using FibroScan technology? <h3>Methods</h3> We employed FibroScan technology, a validated transient elastography method, to evaluate patients with gout. Consecutive gout patients with insurance coverage were evaluated at one center from 11/1/2016 - 11/12021. We assessed the Fibrosis score (kPA) that measures liver stiffness (E score) and the controlled attenuation parameter dB/m (CAP) score that assesses steatosis. In addition, we assessed the four-factor fibrosis (FIB-4) Index formula that combines the patient's age with aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count. <h3>Results</h3> 47 gout patients (7 females, 14.9%; 40 males, 85.1%) were evaluated. The mean age was 59.8 years, and the mean BMI was 30.95 kg/m2. Tophi were present in 11 (26.2% of those with recorded information). The disease's duration ranged from 0-49 years. Comorbidities included: dyslipidemia (86.7%), diabetes (31.1%), hypertension (63.6%), CHF (12.8%), CAD (12.8%), chronic kidney disease (19.15%), known liver disease (33.3%) and current alcohol consumption (46.8%). 53.7% (n=29) had hyperuricemia (serum urate (SU) &gt;6.8 mg/dL) and 54.4% had elevations of either ALT or AST. Hepatic steatosis (CAP &gt;238 dB/m) was found in 40 (85.1%) and was not significantly different in males or females (p=0.37) or those with CHF (p=0.87), CAD (p=0.94), hypertension (p=0.17), diabetes (p=0.68), dyslipidemia (p=0.59) or the presence of known liver diseases (p=0.37). CAP correlated with BMI (r=0.53, p=0.0001) but not age, SU, glucose, triglycerides, ALT, AST, FIB-4, or Fibrosis scores. By FibroScan, 9 (19.1%) had evidence of fibrosis (E score &gt;7), including one with moderate and 8 with severe fibrosis (cirrhosis). Moderate or severe fibrosis was significantly associated with age (p=0.03) and known liver disease (p=0.003), but not ancestry, gender, BMI, triglycerides, HDL, glucose, gout duration, CHF, CAD, hypertension, dyslipidemia, or diabetes. SU was comparable in those with or without moderate or severe fibrosis (p=0.24). The Fib-4 score was significantly greater in those with severe or moderate fibrosis (3.77) versus those with no or mild fibrosis (1.59, p=0.0045). There was a significant correlation between the Fibrosis score and FIB-4 score (r2=0.24, p=0.0009) but not between the Fibrosis score and ALT (p=0.44) or AST(p=0.41). <h3>Conclusion</h3> Hepatic steatosis and fibrosis are common in patients with gout but not associated with typical gout comorbidities. Screening for NAFLD with elastography should confirm the actual frequency of NAFLD in gout and provide a means to manage this comorbidity more effectively. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Naomi Schlesinger Consultant of: has been on advisory boards and consulting for Novartis, Horizon Pharma, SOBI, Protalix, and ANI., Ankoor Patel: None declared, Vinod Rustgi: None declared, Anthony Yeo: None declared, Peter Lipsky: None declared.